Culture and nonverbal expressions of empathy in clinical settings: A systematic review

Lorié, Áine; Reinero, Diego A.; Phillips, Margot; Zhang, Linda; Riess, Helen

doi:10.1016/j.pec.2016.09.018

Cited by 144 publications

(106 citation statements)

References 71 publications

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“…Although we had a diverse group of participants, contextual tailoring and cultural sensitivity is an important consideration in extending this work. The need for a consideration of gender, physician culture and patient culture, and how these interact to promote cross‐cultural competency in NVCS and relationship‐centred care, has been noted in a recent systematic review . Further incorporating drama‐based activities into curricula requires additional faculty member development, and our next step is to offer workshops in our institution.…”

Section: Discussionmentioning

confidence: 99%

“…Numbers indicate the specific workshop: workshop 1, drama games; workshop 2, experiencing touch culture, and how these interact to promote cross-cultural competency in NVCS and relationship-centred care, has been noted in a recent systematic review. 1 Further incorporating drama-based activities into curricula requires additional faculty member development, and our next step is to offer workshops in our institution. One option might include partnering medicine-and arts-based faculty members to promote medical-humanities partnerships, and to demonstrate both the biomedical and humanistic dimensions of clinical care.…”

Section: Listen To All We Hearmentioning

confidence: 99%

“…Non‐verbal communication skills (NVCS) account for 60–90% of interpersonal communication, and medical graduates are expected to demonstrate effective NVCS in patient care. NVCS mediate both empathic understanding and the exchange of emotional information, thereby promoting relationship‐centred care .…”

Section: Introductionmentioning

confidence: 99%

“…NVCS mediate both empathic understanding and the exchange of emotional information, thereby promoting relationship‐centred care . Good NVCS increase patients’ satisfaction, treatment adherence and use of health care services, whereas physicians with poor NVCS are more likely to face malpractice claims …”

Section: Introductionmentioning

confidence: 99%

“…2 Good NVCS increase patients' satisfaction, treatment adherence and use of health care services, whereas physicians with poor NVCS are more likely to face malpractice claims. 1,2 Educational strategies to promote NVCS are neglected in medical curricula. 2 Only six of the 71 components of the evidencebased and widely used Calgary-Cambridge Guide on communication skills draw attention to NVCS.…”

Section: Introductionmentioning

confidence: 99%

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Drama to promote non‐verbal communication skills

Kelly

Nixon

Broadfoot

et al. 2018

The Clinical Teacher

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Section: Discussionmentioning

confidence: 99%

Section: Listen To All We Hearmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drama to promote non‐verbal communication skills

Kelly

Nixon

Broadfoot

et al. 2018

The Clinical Teacher

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Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter

Zulman

Haverfield

Shaw

et al. 2020

JAMA

170

173

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IMPORTANCE Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction.OBJECTIVE To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients.EVIDENCE REVIEW Preliminary practices were derived through a systematic literature review (from January 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (−4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their "top 5" practices from among those with median ratings of at least +2 for all 3 criteria. Final recommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes. FINDINGSThe systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient's story (consider life circumstances that influence the patient's health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient's emotions). CONCLUSIONS AND RELEVANCEThis mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.

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